| NPI | 1265042204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORNAYRA POWELL-GROSS Owner 667-232-1717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family |
| Enumeration Date | 2020-08-05 |
| Last Update Date | 2020-08-05 |